Which statement correctly describes how nondepolarizing neuromuscular blockers are reversed and what agent is commonly co-administered?

• A. Sugammadex is used to reverse nondepolarizing neuromuscular blockers
• B. Acetylcholinesterase inhibitors such as neostigmine, typically given with an anticholinergic such as glycopyrrolate
• C. High-dose inhalational anesthetics reverse blockade
• D. Cholinergic agonists reverse blockade

Answer: (B)

Nondepolarizing neuromuscular blockers are reversed by increasing acetylcholine at the neuromuscular junction. An acetylcholinesterase inhibitor like neostigmine raises endogenous acetylcholine levels, outcompeting the blocker at the nicotinic receptors and allowing motor transmission to resume. Because this higher acetylcholine also stimulates muscarinic sites, an anticholinergic such as glycopyrrolate is given to block these unwanted effects (bradycardia, excess secretions) while still enabling reversal. This combination—an acetylcholinesterase inhibitor with an anticholinergic—is the standard approach for reversing nondepolarizing blockers. (Sugammadex can rapidly reverse certain aminosteroid blockers like rocuronium and vecuronium, but it’s not the universal method for all nondepolarizing agents.)